Key result
Assuming an ellipse geometry of the mitral annulus, the QPD-MAA4C+A2C method accurately assessed mitral regurgitation volume with no significant difference compared to RT3DE.
Why the study?
Mitral regurgitation volume by quantitative pulsed Doppler suffers from geometric assumption error due to assuming a circular mitral annulus.
Does an ellipse geometric assumption of the mitral annulus improve the accuracy of mitral regurgitation volume assessment by quantitative pulsed Doppler compared to a circular assumption?
Observational (n=88)
No
Does an ellipse geometric assumption of the mitral annulus improve the accuracy of mitral regurgitation volume assessment by quantitative pulsed Doppler compared to a circular assumption?
Using an ellipse geometric assumption rather than a circular one for the mitral annulus improves the accuracy of mitral regurgitation volume assessment by 2D transthoracic echocardiography.
Answers are grounded in this paper and cite their sources.
Supports elliptical mitral annulus assumption for 2D MRvol accuracy; leaves open prospective validation before practice change.
Background Mitral regurgitation volume (MRvol) by quantitative pulsed Doppler (QPD) method previously recommended suffers from geometric assumption error because of circular geometric assumption of mitral annulus (MA). Therefore, the aim of this study was to evaluate the impact of different geometric assumption of MA on the assessment of MRvol by two-dimensional transthoracic echocardiographic QPD method.Methods This study included 88 patients with varying degrees of mitral regurgitation (MR). The MRvol was evaluated by QPD method using circular or ellipse geometric assumption of MA. MRvol derived from effective regurgitant orifice area by real time three-dimensional echocardiography (RT3DE) multiplied by MR velocity-time integral was used as reference method.Results Assumption of a circular geometry of MA, QPD-MAA4C and QPD-MAPLAX overestimated the MRvol by a mean difference of 10.4 ml ( P < 0.0001) and 22.5 ml ( P < 0.0001) compared with RT3DE. Assumption of a ellipse geometry of MA, there was no significant difference of MRvol (mean difference = 1.7 ml, P = 0.0844) between the QPD-MAA4C+A2C and the RT3DE.Conclusions Assuming that the MA was circular geometry previously recommended, the MRvol by QPD-MAA4C was overestimated compared with the reference method. However, assuming that the MA was ellipse geometry, the MRvol by the QPD-MAA4C+A2C has no significant difference with the reference method.
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Wang et al. (2019) conducted an observational in Mitral regurgitation (n=88). Quantitative pulsed Doppler using ellipse geometric assumption of mitral annulus (QPD-MAA4C+A2C) vs. Quantitative pulsed Doppler using circular geometric assumption (QPD-MAA4C) and RT3DE was evaluated on Mean difference in mitral regurgitation volume compared to RT3DE (ml) (95% CI -16.6 to 20.1, p=0.0844). Assuming an ellipse geometry of the mitral annulus, the QPD-MAA4C+A2C method accurately assessed mitral regurgitation volume with no significant difference compared to RT3DE.
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